Complications Of Facial Palsy Research Articles

Validation of a New Graphic Facial Nerve Grading System: FAME Scale.

Background and Objective:Most of the existing qualitative facial nerve grading systems are very subjective while the quantitative grading systems are more complex, require longer data input time and specific software. There is a need for having a scoring system with graphic criteria to improve the subjectivity, reliability and convenience. We aimed to develop and validate such a reliable graphic scale for use in Bell's palsy.Methods:Face videos of patients with unilateral facial paralysis were recorded using smartphones and analyzed for six items including five voluntary facial movements apart from complications of facial palsy (synkinesis, hyperkinesis, and contracture). 15 videos were used for pilot study, 75 for the development of scale and 110 for its validation. Each video was rated on two separate occasions by 3 independent raters, a score of 0-4 was assigned to each item using the graphic scoring criteria, and a composite score was obtained (range 0–24). Five disease severity categories: normal (score 0), mild (score 1–6), moderate (score 7-12), severe (score: 13–18) and profound facial weakness (score: 19-24).Results:The proposed scale and its component items had high inter-rater and intra-rater reliability (Kappa >0.7). Good correlation (Pearson co-efficient >0.7) was seen among the voluntary movements. The proposed scale is a valid tool to score motor deficits and complications of facial palsy.Conclusions:The proposed scale is a valid and reliable graphic scale to describe facial motor dysfunction and its secondary defects.

Chirurgische Korrektur des paralytischen Lagophthalmus

Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20-35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.

Acute facial palsy (Bell's palsy): A new indication for botulinum toxin?

Background : Botulinum toxin injections in treatment of complications of facial palsy are already common and routine practice for us. Mimic asymmetry as the main aesthetic complication is often due to the hypertonus of mimic muscles of the healthy side of the face. Goal : We supposed that temporary relaxation of mimic muscles of the healthy side would provide better and more correct activation of paralyzed muscles and prevent the development of later mimic asymmetry of the face. Results : 5 patients with acute facial palsy (2 men, 3 women, aged 30.5 years) underwent pilot treatment with botulinum toxin. In addition to standard medications, mimic muscles of the opposite side were injected on the 2–5 days of facial paralysis with Botox ® (average dose: 45 U, in 3 patients) or Dysport ® (average dose: 150 U, in 2 patients). Preliminary results show that the rehabilitation period was shorter than usual, activation exercises of weakened muscles were performed more correctly, and mimic asymmetry in 6–9 months was less than usual in this period. Conclusion : The preliminary results of botulinum toxin injections in acute facial palsy are optimistic and need further investigations.